PhilHealth restores accreditation of 2 hospitals in Koronadal being investigated for fraud

GENERAL SANTOS CITY (MindaNews / 24 Oct) – The Philippine Health Insurance Corp. (PhilHealth) has partially restored “effective this week” the accreditation of two hospitals based in Koronadal City that are being investigated for alleged fraud.

Ricardo Morales, PhilHealth president and chief executive officer, disclosed the move as he confirmed that they have recalled the withdrawal of accreditation it earlier issued against the Dr. Arturo P. Pingoy Medical Center (DAPPMC) and the Allah Valley Medical Specialists Center Inc. (AVMSCI).

He said they decided to allow the two hospitals to continue rendering services to its members for procedures that are not covered by the ongoing investigation against them.

“But procedures that are involved in suspected fraud, they will be stopped for now,” he said in an interview over Radio Mindanao Network in Koronadal on Wednesday.

In a public advisory issued last Oct. 10, PhilHealth-Region 12 announced that it has withdrawn the accreditation of DAPPMC and AVMSCI effective the same day for alleged involvement “in the commission of fraudulent activities.”

It also suspended for six months the General Santos Doctors Hospital Inc. here effective last Monday, Oct. 21, but the implementation has been “held in abeyance” based on an order from its arbitration office.

Morales said he talked with the medical directors of the two hospitals early this week and came up with the agreement.

He said they earlier reviewed their systems and processes and decided to limit the sanctions to suspect fraudulent procedures until the final resolution of the cases are released.

Morales said they are set to issue the guidelines for such arrangement and the medical procedures that will not be included in the PhilHealth coverage.

He clarified that the supposed violations committed by DAPPMC and AVMSCI do not include dialysis services, noting that he only mentioned it as an example during a previous interview in Manila due to the “WellMed controversy.”

WellMed, a dialysis center based in Metro Manila, is undergoing investigation for allegedly claiming PhilHealth reimbursements for alleged “ghost patients.”

Morales said DAPPMC and AVMSCI were allegedly engaged in “upcasing” or elevating of cases of admitted patients to increase their reimbursement claims from PhilHealth.

He cited, as example, a patient admitted with colds or upper respiratory (tract) infection but reported to the agency as pneumonia cases.

The agency is currently identifying the procedures involved in the alleged “upcasing” and will disseminate them to the public through PhilHealth-Region 12, he said.

Morales said the investigation against DAPPMC and AVMSCI will continue on their level and they are currently in the process of “collecting evidences, affidavits and records” pertaining to the cases.

He assured that the concerned hospitals will be given due process and the chance to answer for the alleged violations.

“We have to get to the bottom of this. It involves the people’s money so we have to be extra careful,” he said.

Dr. Antoniette Ladio, PhilHealth-12 acting regional vice president, earlier said the withdrawal of accreditation to DAPPMC and AVMSCI was a form of “preventive penalty.”

The two hospitals, which are among the biggest in Koronadal City and South Cotabato province, immediately filed motions for reconsideration regarding the move. (MindaNews)